Department of Medicine, University of Auckland Auckland, NZ.
Ther Clin Risk Manag. 2006 Mar;2(1):77-86.
Bisphosphonates, pyrophosphate analogs which potently inhibit osteoclastic bone resorption, are now firmly established as first-line therapy for osteoporosis. Several bisphosphonates of varying antiresorptive potency are either in clinical use or well advanced in clinical trials. Alendronate and risedronate are agents of choice at present because data from randomized controlled trials demonstrate that each of these nitrogen (N)-containing-bisphosphonates reduces the incidence of vertebral and nonvertebral fractures by about 50%, whereas evidence for antifracture efficacy is limited to the vertebral site currently for other bisphosphonates such as etidronate and ibandronate. There have not been direct studies comparing the antifracture efficacy of alendronate with that of risedronate. Intermittent administration of bisphosphonates is now a well established clinical practice, and the potent bisphosphonate zoledronate produces suppression of bone resorption for at least 12 months after a single intravenous dose. Future research will better define how to optimally administer these agents to maximize efficacy and patient compliance. The place in osteoporosis therapeutics of combining bisphosphonate therapy with agents that primarily stimulate bone formation, such as parathyroid hormone, remains to be defined.
双膦酸盐是一种强效的破骨细胞骨吸收抑制剂，现已成为骨质疏松症的一线治疗药物。目前有几种具有不同抗吸收作用的双膦酸盐正在临床应用或临床试验中取得良好进展。阿仑膦酸盐和利塞膦酸盐是目前的首选药物，因为随机对照试验的数据表明，这两种含氮双膦酸盐都能将椎体和非椎体骨折的发生率降低约 50%，而其他双膦酸盐（如依替膦酸盐和伊班膦酸盐）的抗骨折疗效目前仅局限于椎体部位。目前还没有直接研究比较阿仑膦酸盐和利塞膦酸盐的抗骨折疗效。双膦酸盐的间歇性给药现在是一种成熟的临床实践，单次静脉注射唑来膦酸盐后，至少能抑制 12 个月的骨吸收。未来的研究将更好地确定如何最佳地使用这些药物，以最大限度地提高疗效和患者的依从性。将双膦酸盐治疗与主要刺激骨形成的药物（如甲状旁腺激素）联合用于骨质疏松症治疗的地位仍有待确定。
